Healthcare Provider Details

I. General information

NPI: 1821474610
Provider Name (Legal Business Name): GAILYNN ROMERO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2015
Last Update Date: 03/04/2025
Certification Date: 03/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 ANITA ST
PUEBLO CO
81001-2122
US

IV. Provider business mailing address

1401 ANITA ST
PUEBLO CO
81001-2122
US

V. Phone/Fax

Practice location:
  • Phone: 719-225-6510
  • Fax:
Mailing address:
  • Phone: 719-225-6510
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLSW.0009926139
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: